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Special Alert January 2026 - Carelon Radiotracer Management for PET Imaging
Providence Health Plan·Nuclear Medicine, Oncology, Radiology·Pharmacy
Effective date
Apr 1, 2026
We identified it
Oct 6, 2026
Summary
Effective April 1, 2026, Carelon will require both PET and radiotracer CPT codes to be submitted together during the authorization process for Brain PET and Oncologic PET procedures. Approved authorizations will specify which radiotracer categories are allowed. Cardiac PET remains out of scope. This change affects the prior authorization workflow for Providence members.
Action Required
Previously due April 1, 2026 (date passed; verify current applicability): Billing team and prior authorization staff must implement changes to the authorization submission process for Carelon/Providence members. (1) Update authorization request templates and workflows to require submission of BOTH the PET CPT code AND the radiotracer CPT code together at intake. (2) Train staff to submit Brain PET and Oncologic PET authorization requests with paired PET and radiotracer codes, grouping radiotracers by guideline category (Oncologic Imaging, Brain Imaging, Chest Imaging). (3) Ensure authorization response documentation captures the approved radiotracer category specified by Carelon, not individual radiotracers. (4) Exclude Cardiac PET procedures from this dual-code submission requirement. (5) Contact Carelon MBM at (800)-252-2021 with questions on specific radiotracer categorization or authorization guidelines. Failure to submit both codes together may result in authorization delays or claim denials.